Teletherapy has lowered barriers to regular visits and significantly increased access to mental health care during the COVID-19 pandemic, according to a large claims study released at the JAMA Health Forum on Friday.
The study found that from March 2020 to August 2022, mental health visits increased by 39% and spending increased by 54%. A review of his 1,554,895 claims for clinician visits also found that his use of telemedicine increased tenfold.
Because the study covered visits to approximately 7 million adults nationwide who had health insurance through their employers, many patients with very severe mental illness were excluded, and acute care and residential treatment are not covered.
Christopher M. Whaley, a health economist at the RAND Corporation and study author, said the price hikes are likely to persist even as insurers consider the merits of continuing to pay more. said.
“This is a huge cost, and we’re paying for it through higher premiums and higher deductibles,” said Brown University associate professor Whaley.
On the other hand, patients with unmet mental health needs are less likely to take medication and more likely to use the emergency room during a crisis, a behavior that also adds significant costs to insurance pools. It will be passed on, he added.
“The challenge for insurers, and what we have to think about as a healthcare system, is how much does it really cost,” Waley said.
Most of the mental health visits were for anxiety and depression, accounting for 45 percent and 33 percent of the total visits, respectively. Visits due to post-traumatic stress disorder accounted for 10%. Bipolar disorder, 9 percent. and schizophrenia, 2.6 percent.
Of the five diagnoses, anxiety disorders saw the largest surge in visits during the pandemic, at 73.7%. His PTSD visits increased by 37%. Bipolar visits decreased by 32 percent. And the number of people with depression decreased by 31.9 percent. The number of hospital visits for schizophrenia did not change.
Researchers were surprised to find that the use of telemedicine in mental health, unlike other medical fields, did not decline as the pandemic ended.
“This is the only area of the healthcare system where patients and providers are in some sense voting on their own terms.,” Whaley said: “This is a change that will likely continue beyond the pandemic. ”
Dr. Robert L. Trestman, chief of psychiatry at Virginia Tech’s Carillion School of Medicine and overseer of the western mental health system, said increased access to mental health services is a sign of receding stigma and practical barriers to mental health access. He said it reflected both declines. Virginia.
Dr Trestman said his system has resulted in an “incredible increase in billings” for anxiety and depression patients in the years of the pandemic. He said that historically, nearly half of people with symptoms of these disorders do not receive mental health care.
As more people seek treatment, the numbers “are actually more consistent with what we expect the underlying epidemiology to be,” he said.
Dr. Trestman, who is also president of the American Psychiatric Association’s Council on Health Care Systems and Finances, said, “They are constrained because they have to find a clinician and have to take time off work to get to a doctor. I was there,” he said. “The public health emergency and the expansion of telemedicine have practically removed these restrictions.”
He added that he expects this trend to continue as Americans manage financial and housing concerns and loan repayments post-pandemic.
“We don’t see any evidence of a decline that we’re seeing or predicting,” he said.
It’s unclear whether insurers will try to curb high levels of spending.
Patients have long complained about the difficulty of getting reimbursed mental health visits, despite the passage of federal Mental Health Equality and Addiction Equity Act of 2008.
Dr. Jane M. Zhu, an associate professor of medicine at Oregon Health and Science University who has researched accessibility, said insurers were worried that telemedicine would prevent patients from accessing more expensive treatments, such as emergency room access during mental health crises. He said it was necessary to determine whether Mental health services.
“It will drip at some point,” she said. “Either more people using telemedicine will increase total spending, or insurance companies will look for ways to reduce spending.”
Dr. Zhu said telemedicine acceptance varies by population. A 2022 study published in the journal Health Affairs found that patients with schizophrenia were slower to switch to telemedicine, while those with anxiety and fear-related disorders switched to telemedicine sooner. found.
A 2022 analysis by the Federal Office for Health Policy found significantly lower adoption of telemedicine among the uninsured and young people. Video visits are highest among whites and high-income earners and lowest among those with lower education. People aged 65 and over. And Latinos, Asians, and blacks.
Dr. Zhu said the increase in service usage was significant.
“I haven’t seen anything like that in the literature,” she said. “Obviously, this is a whole new era.”
